Expressing breast milk

Hand expressionThe easiest time to learn hand expression is during a feeding. The let-down reflex has triggered the milk to flow in both breasts, making it possible to express milk from the side on which the baby is not nursing. Hand expression becomes easier with practice.

Preparation:

Wash your hands.

Prepare a container to collect the milk. A wide-mouth container or specially designed funnel works well. Wash the container in very hot, soapy water before use. It is not necessary to sterilize the container.

If you are expressing milk without your baby close by, take a few minutes to gently massage your breasts down and out toward the nipple. If possible, apply warm, moist wash cloths to your breasts three to five minutes before expressing. Thinking about or looking at a picture of your baby helps stimulate a let-down reflex.

Steps for hand expressing

Support your breast between your fingers and thumb, which are placed about 1 to 1-1/2 inches back from your nipple. You may have to adjust this position forward or back to get the best results.

Next, roll your thumb and fingers toward your nipple. This motion is not a squeezing or sliding motion, but rather a rolling motion as if you are making thumb and finger prints. Do not squeeze your nipple, only the areola.

Repeat this process, rotating your hand around your breast.

Switching breasts every few minutes will improve your results. It allows your milk to come down and collect in the ducts of the breast you are not expressing.

Expression with a breast pumpWhen can I begin to express breast milk?Your milk supply is being established in the first two to three weeks, so wait until your baby is about three weeks old before using a breast pump, unless recommended for a specific reason.In general, you express milk:

In between breastfeeding, one hour before or one hour after a feeding.

In the early morning, when your milk supply is usually at its highest. For most women, expressing in the morning will produce more milk than in the late afternoon or early evening.

Will I have enough milk for my baby if I am also expressing?Breast milk production is a supply-and-demand system. The more your breasts are stimulated, the more milk will be produced. You should not be concerned about not having enough milk, since the milk is made in response to stimulation, either by your baby nursing or expression.

When can I introduce a bottle?There are many different opinions on this subject. The majority of health professionals recommend waiting at least four weeks before giving a bottle to reduce the chance that your baby will prefer the nipple and/or the fast flow of a bottle. Ask your health care provider for recommendations. Keep in mind that adding formula supplements interferes with your milk supply and breastfeeding success.

Breast PumpThere are many breast pumps available on the market today. Careful selection is very important. Not every pump works for every woman. Research shows some may actually harm the breast tissue. Before buying a breast pump, contact a lactation consultant and/or your health care provider for assistance and recommendations.

Battery-operated pumpsMany battery-operated pumps are available. Some women find them handy and easy to use. However, they are often not strong enough for long-term pumping needs. Battery-operated pumps also tend to be noisier than electric pumps. Look for pumps designed to release the suction now and then to prevent too much pressure.

Electric pumpsMany electric pumps are available, including those with a double pumping attachment for pumping both breasts at the same time. Smaller, lightweight pumps are available for travel or work. Battery packs and adapters are available too, which allow you to power the pump by plugging it into a car cigarette lighter.

There is a difference between electric rental pumps and personal use breast pumps. For safety reasons, personal use breast pumps should not be shared or resold. Refer to manufacturer’s directions for use.

Storing/defrosting expressed breast milk

Milk storage guidelines are different for home and in the hospital. Ask for specific hospital instructions for milk storage if your baby remains or is remitted to the hospital.

Small (4 oz.) disposable bottle bags or plastic or glass bottles may be easiest to use for storing expressed milk. To prevent breakage, be sure not to fill the bag or bottle to the top. Look for bags made especially for storing breast milk.

Breast Milk Storage Guidelines for Home

Storage Type

Freshly Expressed Breast Milk

Thawed Breast Milk (previously frozen)

Room temperature(Up to 77°F/26°C)

Up to 6 hours

Do not store

Insulated cooler bag with ice packs

24 hours

Do not store

Refrigerator(39°F/4°C, back of refrigerator)

Up to 5 days

24 hours

FreezerInside of refrigerator (5°F/-15°C)

2 weeks

Never refreeze thawed milk

Freezer with separate doors

3-6 months

Never refreeze thawed milk

Deeper Freezer (rarely opened) (40°F/20°C)

6-12 months

Never refreeze thawed milk

Academy of Breastfeeding Medicine Protocol #8

Breast milk expands when it freezes. Fill the bottle or bag to within one inch of the top to allow for this expansion. If using a bag, fold the top of the disposable bag over and fasten with a twist tie or rubber band.

Fill the container with 2 to 4 ounces so it will thaw more easily and be about the same amount your baby will eat.

Label the milk container with the date and time expressed.

Use the oldest milk first.

When transporting breast milk for use away from home, keep it cold until just before use. A small cooler with ice or frozen packs may be used to keep the milk cold during transport.

Defrosting:

Thaw breast milk at room temperature or in a bowl of hot tap water. Defrost using the least amount of heat possible. NEVER MICROWAVE BREAST MILK, as it may create hot spots and destroy some beneficial vitamins and enzymes.

Breast milk will often separate when cooled as the cream rises to the top. Mix the milk by gently shaking.

Do not feed defrosted milk to your baby until it is completely thawed.

Some mothers report a slightly soapy smell to their milk after thawing, which is from changes in the milk fats. This is not harmful and can be given to your baby.

If your milk smells or tastes sour, it should be discarded. If you have questions about the smell of your milk, contact your local lactation consultant for more information.